B. tropicalis was detected in mattress and in floor- dust samples, reflecting a high concentration of allergen (2, 3). A study of six indoor allergens in the homes in.
ALLERGY 1998: 53:1226-1235
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ISSN 0105-4S38
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similarity of climate and humidity between Jakarta and Singapore, we decided to re-examine the dust-mite profile of homes of allergic patients in Jakarta. Dust samples were collected from the OUSE DUST mites are an important source of bedroom, living room, and kitchen of 102 homes inhalant allergens and play a definitive role in of bronchial asthma, allergic rhinitis, and other the pathogenesis of bronchial asthma and allergic allergic patients in Jakarta and further identified diseases. Skin tests performed on our patients with and quantified by standard techniques. This bronchial asthma and allergic rhinitis yielded a preliminary communication reports the dustpositive reaction rate of 87% to Dermatophagoides mite fauna from the first 10 of 102 homes. Mites pteronyssinus. Earlier analysis of the house dust of the Dermatophagoides spp. were predominant, taken from the living environments of our asthma D. farinae (39.4% of total mites isolated) and D. pteronyssinus (25.4%) making up the majority of patients revealed the presence of this species of the counts. This was followed by B. tropicalis dust mite. In addition, previous field studies (14.1%). Other species of mites found included performed in several dormitories in Jakarta. Sturnophagoides sp. (7.0%), Tyrophagus putresIndonesia, found this mite to be the most prevalent centiae (4.2%), Austroglycyphagus sp. (1.5%), species. Other mite species found in this earlier study included Glycyphagus destructor, Cheyletiella Cheyletus sp. (1.5%), and unknown (6.9%). Carpets were found to have the highest mite erudetus, and Swicounts (240-320 mites/g) followed by bed matdasis and TarsoneDust mites, especially D. mus tresses (40-420 mites/g) and upholstered sofas species (1). D. (40-100 mites/g). During this study, the temperafarinae, D. pteronyssinus, farinae or Blomia ture range in the homes was 26-30°C, and the tropicalis (Bio t) and B. tropicalis, are humidity range was 50-70%. were not found in Ouantification of more house-dust samples is the previous study. very common in the currently underway. A further enzyme immunoB. tropicalis has homes of allergic assay study of the house dust used in this study to become more recogquantitate the presence of Der p 1, Der f 1, and Bio nized as an imporpatients. t is also underway. Preliminary data showed tant allergen source in tropical and sub- significantly higher levels of Der f 1 than Der p 1 (6). tropical areas of the world, such as South and Central In conclusion, dust mites are highly prevalent America, the southern USA, and the Far East. B. tropicalis was detected in mattress and in floor- in Jakarta homes, D. farinae being the predominant species present, followed by D. pteronyssidust samples, reflecting a high concentration of nus, and B. tropicalis and D. farinae might be as allergen (2, 3). important as D. pteronyssinus in the sensitization A study of six indoor allergens in the homes in of allergic patients in a tropical area such as Singapore measured by specific immunoassays (for Jakarta. Der p 1, Der f 1, Bla g 1, Fel d 1, and Can f 1) and by Key words; Blomta tropicalis. Dermatophagoides farinas. Dermatophagoides fluorescent allergosorbent test (FAST) inhibition pteronysstnus, house dust mite; tropical area. assays (for B. tropicalis) showed that the mite I. R. BARATAWIOJAJA", P. P. BARATAWIDJAJA, A . DARWIS, F . C . Y I , FT.CHEW, allergens Der p 1, Der f 1, and Bio t were the most B.W. LEE, K. G . BARATAWIDJAJA prevalent allergens found. Of the group 1 mite "Allergy and Immunology Division allergens, Der p 1 was predominant. D. pteronyssiDepartment of Medicine nus and D. farinae, as well as B. tropicalis, were Faculty of Medicine found in high concentration in mattresses and University of Indonesia Jakarta carpets (4). This was later confirmed via direct mite Indonesia isolation and quantification (5). Jakarta is situated in a tropical area located Accepted for publication 2 July 1998 only 1500 km from Singapore. In view of the Copyright r Munksgaard 1998 ALLERGY 1998 53:1226 1227 recent results of the Singapore study and the
Mites in Jakarta homes
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REFERENCES 1. Baratawidjaja K, Sundaru H, Samsuridjal D. Sukmana N. Allergic diseases in Indonesia. Allergy Clin Immunol 1992;4:166 70 2. Puerta L, Fernandez-Caldas E, Mercado D, Lockey RF, Caraballo LR Sequential determinations of Blumia iropicalis allergens in mattress and floor dust samples in a tropical city. J Allergy Clin Immunol 1996:97:689 91 3. Platts-MillsTAE.Vervloet D.ThomasWR, Aalberse RC, Chapman MD. Indoor allergens and asthma: report of the third international workshop. J Allergy Clin Immunol 1997:100:S1 S24 4. Zhang L, Chew FT, Soh SY, et al Prevalence and distribution of indoor allergens in Singapore Clin Exp Allergy 1997:27:876 -85 5 Chew FT, Zhang L, HoTM, Lee BW. House dust mite fauna in tropical Singapore Clin Exp Allergy (submitted) 6 Baratawidjaja IR, Baratawidjaja PP Darwis A, et al. Indoor allergen profile study by immunoassay of 102 homes in Jakarta, Indonesia [Abstract]. Asian Pacific Congress of Allergology and Clinical Immunology, Manila, 1998.
Anaphylaxis to pine nuts UNGINGER et al. (1) report on seven instances of anaphylaxis induced by food in patients between the ages of 11 and 43 years, all atopic, with some multiple anaphylactic episodes, after eating the suspected food (peanuts, four patients; fish, one patient; crab, one patient; pecan nuts, one patient). We describe a strange case of anaphylaxis induced by pine nuts in a patient with atopic inhalation diathesis. In September 1995, after a meal of spaghetti and pesto sauce (olive oil, herbs, pine nuts, sardines), a 53-year-old man experienced angioedema, acute dyspnea, and circulatory collapse for the A severe reaction in an first time. The patient was treated with atopic, 53-year-old man intravenous injection of antihistamine as with birch-pollen well as glucocortiallergy. coid. He was referred -——^^———'^—^—— to us for identification of the allergen responsible for the anaphylactic reaction. Skin prick tests were performed with seasonal and perennial inhalation allergens (Bencard Allergy Service, Munich, Germany) and native material of the suspected food. The implementation and evaluation of the prick tests were carried out in line with the guidelines of the EAACI (2). For birch pollen and house-dust mite (Dermatophagoides farinae), a positive test reaction was discovered twice, and rhinoconjunctivitis allergica saisonalis et perennialis was thus identified. There was a negative reaction to ohve oil, tuna fish.
Y
Table 1. Results of allergenic test Test procedure
Substance
Test reaction
Prick test
Pine nuts Inative) Birch pollen
++ ++
Dermatophagoides farinae
-t- +
Oral provocation test
Pine nuts (several, i.e, one teaspoonful)
Positive
Tartrazine 100 mg
Negative
3,4-OihydroxY-cinnamic acid
Negative
(caffeic acidl 100 mg 2-Hydroxy-Cinnamic acid
Negative
(/tvcoumaric acid) 100 mg 4-Hydroxy-3-methoxy-cinnamic acid
Negative
(ferulic acid) 100 mg Na-salicylate 500 mg
Negative
(fll-p-hydroxybenzoate (pHB) 500 mg
Negative
Na-benzoate 500 mg
Negative
Sorbic acid 500 mg
Negative
Na-metabisulfite (cumulative 310 mg|
Negative
pistachios, basil, marjoram, oregano, black pepper, sardines, and various shellfish in the prick test, whereas the pine nuts were double positive. Oral provocation tests were conducted with food colorings, antioxidants, and preservatives, which did not produce a reaction (Table 1). Finally, the patient was exposed to pine nuts: 10 min after being given a teaspoonful of pine nuts, the patient reacted with marked conjunctival inflammation, periorbital reddening, and itching. After he was given 4 mg Fenistil" (Dimetindenmaleat) and 200 mg Urbason* (methylprednisolone) intravenously, there was a reversal of symptoms. Serologic analysis for specific IgE antibodies (CAP, RAST FEIA, Pharmacia Company, Freiburg, Germany) was found to be strongly positive (class 4) for pine nuts. Pine nuts are used in bread, pastries, and Italianstyle meals. The kernels released from the hard shell can be consumed as a valuable nutrient, containing approx. 39% protein and 50% fat. Halsey et al. (3) report on type I allergy to sunflower seeds. Immediate-type allergies to pine nuts are very rare. Only one case of systemic reaction to pine nuts was presented by Nielsen (4). On one occasion in September 1995, our patient suffered angioedema, acute dyspnea, and circulatory collapse, after consumption of spaghetti and pesto sauce (olive oil, herbs, pine nuts, sardines). On the basis of patient's history, RAST, skin test, and exposure, we were able to prove type I allergy to pine nuts, which caused the anaphylactic reaction. Key VKords anaphylaxis: food allergy, pine nuts. A.V. BEYER", H . GALL, R, U . PETER
* Department of Dermatology University of Ulm Oberer Eselsberg 40 89081 Ulm Germany
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